UW to provide training on managing pain with marijuana

The University of Washington has set out to help healthcare providers understand and use marijuana in pain management. (Getty Images)

To “benefit people suffering from chronic pain,” the state attorney general’s office has awarded the University of Washington $110,000 to find out how marijuana is used to treat pain and then train healthcare providers to do just that … when appropriate.

Chalk this up as one more step in the evolution of marijuana from “enemy of the state” to studied, integrated and accepted.

“I’m proud to be a resident in a state that has come forward to fund what we are doing,” said UW’s lead researcher in this effort, Beatriz Carlini. “Because I think definitely that it can benefit our population, particularly chronic pain sufferers. So, I’m really proud of that too and amazed.”

Indeed.

From UW’s application to do the work: The addition of medical cannabis to the menu of options to treat chronic pain in our State brings new hope to many Washingtonians. Washington has one of the highest rates of opiate-related mortality in the country, often the result of mismanagement or abuse of medications prescribed to alleviate chronic pain. Misconceptions about medical cannabis and the lack of science-based education for professionals hinder the benefits that the medical cannabis law can bring to those struggling with chronic pain.

Big pharma failure paying for it

The story of how our attorney general’s office came to grant the money to UW’s Alcohol and Drug Abuse Institute in October involves wrongdoing, a successful election and the growing acceptance of legal pot.

In short, the pharmaceutical giant Pfizer agreed to pay more than $42 million in a suit brought by several states, Washington among them, because it “unlawfully promoted its drugs, Zyvox and Lyrica,” according to a news release from last year when the settlement was announced.

The key charge, for this story, was this:

Lyrica is FDA-approved for seizure control and nerve pain in diabetics, among other illnesses. Pfizer marketed the drug as a more potent successor to Neurontin, another drug that has been used effectively for years.

Former Washington Attorney General Rob McKenna said “the drug maker engaged in illegal marketing for Lyrica by encouraging its use for the treatment of pain conditions for which the drug is not approved by the FDA.”

Washington was granted $1.3 million in the settlement.

Then voters approved Initiative 502, creating a legal marijuana market on top of an already 15-year-old medical marijuana system … and now marijuana is a hot topic and will soon be legally and widely available.

And, since the Pfizer money had to be used to “address direct treatment or research related to chronic pain,” the current AG’s office decided to tackle the growing popularity and concern over using marijuana as a treatment for pain.

“The grant committee reviewed a variety of projects for breadth of impact as well as geographic, ethnic and project diversity. This UW research project will provide scientific-based information about the medicinal use of marijuana — including chronic pain management,” Janelle Guthrie, spokeswoman for the AG’s office, wrote us in an email.

UW sets out to fill the knowledge gap

More people will be asking their healthcare providers about marijuana and many who could benefit from medical marijuana might not be getting it because of uncertainty in the medical community. And that’s just the problem the UW team has set out to solve.

“We are going to provide scientific-based, evidenced-based (information) on medical cannabis for treating chronic pain. We are not going to do that just from the top of our head,” Carlini said.

First steps are to find out what knowledge is already out there — what clinicians know about the topic, what challenges and barriers they face for using it, what kind of information they want and what questions they have.

“We are working with a broad group of consultants. Some of them, actually most of them, are people who have been working as a clinician (and) recommending medical cannabis for their patients, based on science and clinical evidence that works,” she said.

“That being said, we will not ignore other evidence for when it should not be used or side effects or potential gaps in knowledge” of how marijuana works and works best, Carlini added.

“We are committed to fostering wellbeing and public health in general, and we aim to provide some science-based information so this opportunity is one them … to advance knowledge. We don’t have any political or moral agenda at stake here. It’s just what we do here. We try to provide the best knowledge, point out the gaps and provide the best science,” she said.

It’s well worth reading through the “project description” below. And, if you’re into looking under the hood for how a grant like this is applied for, check out the embedded document at the bottom of this story.

This project addresses gaps in science-based training and education in the area of chronic pain management and cannabis use. The ultimate goal is to increase awareness of treatment options to treat pain and other medical conditions, and decrease unnecessary suffering among people living with chronic pain in the state of Washington. The project will also provide information and education about medical conditions and populations for whom cannabis is not recommended, side-effects and risks.

Chronic pain is an emerging public health challenge aggravated by an aging U.S. population. The Institute of Medicine reports that 100 million Americans suffer from chronic pain conditions. A subset of this population is afflicted by intractable pain associated with cancer, neuropathic diseases, and central pain states (e.g., pain associated with multiple sclerosis). These conditions are often inadequately treated with available opiates, antidepressants and anticonvulsant drugs. Meanwhile, there is a growing body of evidence demonstrating the efficacy of cannabis in treating neuropathic pain, muscle spasms, fibromyalgia, and cacechexia, among other conditions.

In 1998, Washington voters approved the use of medical cannabis for various conditions, including intractable pain, defined as “pain unrelieved by standard medical treatments and medications” (RCW 69.51A) and set a corresponding set of quality control standards in place to assure the quality, consistency, and availability of medicinal cannabis for patients receiving chronic pain management.

The addition of medical cannabis to the menu of options to treat chronic pain in our State brings new hope to many Washingtonians. Washington has one of the highest rates of opiate-related mortality in the country, often the result of mismanagement or abuse of medications prescribed to alleviate chronic pain. Misconceptions about medical cannabis and the lack of science-based education for professionals hinder the benefits that the medical cannabis law can bring to those struggling with chronic pain. Health care providers are often reluctant to discuss marijuana use – for medical or recreational purposes – with their patients, due to lack of knowledge and training about the endocannabinoid system, other effects of marijuana, uncertainty about legal issues, and concern about abuse or dependence. Likewise, patients may be reluctant to ask their doctors about safe and effective marijuana use for medical purposes.

The passage of I-502 authorizing the sale of marijuana for recreational purposes seems to be creating even more confusion about the risks and benefits of medical cannabis. While the initiative does not amend or repeal the medical marijuana laws it distracts public opinion and health care providers from the medicinal properties of cannabis, including chronic pain management. Meanwhile, it is likely that the availability of legal marijuana from regulated state stores may motivate more Washingtonians to consider marijuana to treat pain and other conditions.

This project proposes development and provision of training and education resources on chronic pain and medical cannabis for the following target groups: a) staff and volunteers of community organizations that provide information and referral for a range of situations involving substance use and people struggling with chronic and acute conditions (Poison Center, Crisis Clinic and WA Recovery Helpline); b) health care providers and c) the general public.

Given the new legal status of marijuana in WA and the scarcity of training materials, project aims to assess training and information needs regarding marijuana and pain in the target groups above; develop science-based curriculum content appropriate for the needs of these three segments; evaluate the acceptability and feasibility of web-based training delivery of training and information about marijuana and pain treatment.

This proposal builds the decades of commitment by the Alcohol & Drug Abuse Institute (ADAI) to disseminate science-based information to researchers, policy makers, health care professionals, and the public. The ADAI is a focal point for alcohol and drug abuse research at the University of Washington and in the region, benefiting the citizens of Washington by expanding knowledge and providing information. ADAI has created numerous web-based resources for use by health care providers, researchers, and the public, such as StopOverdose.org. Screening & Assessment Instruments, and the NIDA Clinical Trials Dissemination Library.